International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England

Harron K, Gilbert R, Cromwell D, et al.   International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England
BMJ Qual Saf Published Online First: 12 June 2017. doi: 10.1136/bmjqs-2016-006253

Abstract
Objectives  To compare emergency hospital use for infants in Ontario (Canada) and England.
Methods We conducted a population-based data linkage study in infants born ≥34 weeks’ gestation between 2010 and 2013 in Ontario (n=253 930) and England (n=1 361 128). Outcomes within 12 months of postnatal discharge were captured in hospital records. The primary outcome was all-cause unplanned admissions. Secondary outcomes included emergency department (ED) visits, any unplanned hospital contact (either ED or admission) and mortality. Multivariable regression was used to evaluate risk factors for infant admission.
Results The percentage of infants with ≥1 unplanned admission was substantially lower in Ontario (7.9% vs 19.6% in England) while the percentage attending ED but not admitted was higher (39.8% vs 29.9% in England). The percentage of infants with any unplanned hospital contact was similar between countries (42.9% in Ontario, 41.6% in England) as was mortality (0.05% in Ontario, 0.06% in England). Infants attending ED were less likely to be admitted in Ontario (7.3% vs 26.2%), but those who were admitted were more likely to stay for ≥1 night (94.0% vs 55.2%). The strongest risk factors for admission were completed weeks of gestation (adjusted OR for 34–36 weeks vs 39+ weeks: 2.44; 95% CI 2.29 to 2.61 in Ontario and 1.66; 95% CI 1.62 to 1.70 in England) and young maternal age.
Conclusions Children attending ED in England were much more likely to be admitted than those in Ontario. The tendency towards more frequent, shorter admissions in England could be due to more pressure to admit within waiting time targets, or less availability of paediatric expertise in ED. Further evaluations should consider where best to focus resources, including in-hospital, primary care and paediatric care in the community.

Full text is available here

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Violence against nurses working in the emergency department

Workplace violence (WPV) in healthcare organizations can lead to serious consequences that negatively affect nurses’ lives and patient care | International Emergency Nursing

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Highlights:

  • Nurses who experience WPV complain of mental and physical health problems.
  • Nurses’ social and professional lives were affected negatively after facing WPV.
  • WPV consequences negatively impact nurses and the entire healthcare organization.
  • The serious consequences of WPV ultimately harm patient care.
  • Preventing violence will ensure a safe workplace and safer patient care.

Full reference: Hassankhani, H. et al. (2017) The consequences of violence against nurses working in the emergency department: A qualitative study. International Emergency Nursing. Published online: 31 July 2017

Triaging the emergency department, not the patient

Triage, as it is understood in the context of the emergency department, is the first and perhaps the most formal stage of the initial patient encounter | Journal of Emergency Nursing

Bottlenecks during intake and long waiting room times have been linked to higher rates of patients leaving without being seen. The solution in many emergency departments has been to collect less information at triage or use an “immediate bedding” or “pull until full” approach, in which patients are placed in treatment areas as they become available without previous screening. The purpose of this study was to explore emergency nurses’ understanding of—and experience with—the triage process, and to identify facilitators and barriers to accurate acuity assignation.

Full reference: Wolf, L.A. et al. (2017) Triaging the emergency department, not the patient: United States emergency nurses’ experience of the triage process. Journal of Emergency Nursing. Published online: 24 July 2017

New draft recommendations for the care of acute medical emergencies

This draft guideline includes recommendations for the organisation and delivery of emergency and acute medical care | NHS Networks

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Image source: USW-UniLife – Flickr // CC BY-NC-SA 2.0

It includes recommendations for practice and for research. Recommendations are included on:

  • first points of contact with emergency and acute care services
  • alternatives to hospital care
  • opening hours and locations of acute care services
  • services within hospitals
  • ward rounds, transfers and discharges
  • monitoring and managing hospital bed capacity.

Who is it for?

  • Commissioners and providers of health and social care.
  • Health and social care practitioners.
  • People with or at risk of a medical emergency or acute illness, and their families and carers.

Read the full draft here

Winter pressure in A&E: response to Health Select Committee

The government’s response to the House of Commons Health Select Committee report on winter pressure in accident and emergency departments.

This report responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report, Winter Pressure in A&E Departments . It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.

Full document: Government Response to Health Select Committee Report on Winter Pressure in Accident and Emergency Departments

New ambulance service standards

NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time.

  • National response targets to apply to every single 999 patient for the first time
  • Faster treatment for those needing it to save 250 lives a year
  • An end to “hidden waits” for millions of patients
  • Up to 750,000 more calls a year to get an immediate response
  • New standards to drive improved care for stroke and heart attack
  • World’s largest clinical ambulance trial updates decades-old system

The new targets will save lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for the frail and elderly. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others.

Call handlers will change the way they assess cases and will have slightly more time to decide the most appropriate clinical response. As a result cardiac arrest patients can be identified quicker than ever before, with evidence showing this could save up to 250 lives every year.

Full story via NHS England

 

NHS needs more advanced paramedics to ease A&E pressure

Paramedics with advanced training can reduce the number of patients admitted to hospital unnecessarily, says NICE.

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Image source: Carl Spencer – Flickr // CC BY-NC 2.0

NICE is recommending the NHS provides more advanced paramedic practitioners (APPs) to relieve pressure on emergency departments, in new draft guidance. Evidence reviewed by NICE shows that using APPs can reduce hospital admissions by 13% compared with standard paramedics.

The draft guidance also makes wider recommendations about emergency and acute medical services to standardise care across the NHS. It supports NHS England’s Five Year Forward View for the future of emergency medical services.

Full story available here